Provider Demographics
NPI:1013955244
Name:VISHNIA, SAGIT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAGIT
Middle Name:
Last Name:VISHNIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 TERRY RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3811
Mailing Address - Country:US
Mailing Address - Phone:516-263-5160
Mailing Address - Fax:631-751-1278
Practice Address - Street 1:88 TERRY RD
Practice Address - Street 2:SUITE #2
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3811
Practice Address - Country:US
Practice Address - Phone:516-263-5160
Practice Address - Fax:631-751-1278
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694737Medicaid
NYQ60544Medicare UPIN
NY02694737Medicaid